To Your Health

Dear Colin: I’m 32 years old and just got diagnosed with Achilles tendinitis by my primary care doctor. He prescribed an anti-inflammatory, told me to do nothing and let it rest for eight weeks and then start walking, which is going to drive me insane because I’m used to hiking/jogging for an hour five days a week. Is there anything I can do to speed up the process? —Trevor G.

Oh, yes.

Being sedentary for eight weeks may lower inflammation, but it will also destroy fitness while potentially increasing blood pressure, stress, body fat and risk of depression. The trick when dealing with any injury is to stay as active as possible while minimizing stress on the affected region. This holds true for Achilles tendinopathy (the correct term).

The Achilles tendon connects the calf to your heel bone and is subjected to forces up to 12 times body weight during running. Achilles tendinopathy is an overuse injury and diagnosed based on symptom severity and location (the most common Achilles tendinopathy usually occurs 2 to 6 centimeters above your heel).

Achilles tendinopathy is usually caused by a change in running terrain, speed, distance and/or footwear. Pain is usually first felt in the Achilles tendon followed by increased stiffness/pain in the morning, after exercise and progressing to constant. Tendons have poor blood supply, which slows healing and may explain why untreated Achilles tendinopathy-related pain can last for months

Studies comparing exercise, shock-wave therapy, night splints, injections and manual therapy suggest that exercise (including stretching) is the most cost-effective option as long as it’s done purposefully and gradually.

“Strengthening should focus on the hips, thighs and calves because these muscles are vital to distributing forces during weight-bearing activities, which can dramatically lower forces in the Achilles tendon,” said Clifford Mah, a Beaverton-based podiatrist. “The key, of course, is to use safe techniques to avoid aggravating the injured area.”

Lower forces in the tendon not only can help expedite healing, but also prevent injury recurrence. Icing and elevating the affected area will also control inflammation and promote healing.

The standing calf raise is superb not only for the calf, but also for the hip muscles if done correctly. Note that doing a full range-of-motion calf raise (allowing your heel to drop below the forefoot, such as off a stair) is not recommended, because it causes undue stress on the Achilles as well as plantar fascia and can worsen symptoms.

Start with one foot on the ground and another in the air while slightly leaning back and to the opposite side of the grounded leg, holding onto a stable object (such as a door jamb). Then, push up onto the forefoot but remain in the back/opposite side position, keep your knee straight, focus on using the calf muscle and move at a pace of “one-thousand one” for the up phase and “one-thousand two” for the down phase. You should not experience sharp pain during the exercise; if you do, you’re doing something incorrectly and should see your physical therapist for modification.

Stretching the Achilles daily is also essential to facilitate hiking/jogging with minimal symptoms. Note the position; the ball of the foot must be supported to protect the plantar fascia while optimizing an Achilles stretch.

While using exercise to overcome Achilles tendinopathy can take time, it’s worth it to alleviate symptoms now and in the long term. It can also increase libido, cut stress and body fat without side effects. How many pharmaceuticals can claim that?

Colin Hoobler is a licensed physical therapist and has written two books on exercise as treatment for disease and injury

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